Category Archives: WCMSA

The attached Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted to the CMS.gov webpage. This reference guide was created to help explain the WCMSA approval process and to serve as a reference guide for those electing to submit their WCMSAs to CMS for approval. The reference guide consolidates information currently found within the Workers’ Compensation Agency Services … READ MORE

On October 2, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Sponsors concerning the transition to Part D Coverage of Benzodiazepines and Barbiturates beginning in 2013. Effective June 1, 2013, all Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for a review of the adequacy of the proposal amount are to include … READ MORE

A new Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available for download below. This reference guide was created to consolidate information currently found within the Workers’ Compensation Agency Services webpages and CMS Regional Office Program Memorandums, while providing WCMSA information to attorneys, Medicare beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors. Please continue … READ MORE

The WCMSAP or Workers’ Compensation Medicare Set-Aside Portal has been improved to allow for two type of reconsiderations. These reconsiderations have been broken down by CMS into the follow two options: Option 1 If you believe CMS’s determination contains obvious mistakes (e.g., a mathematical error or failure to recognize Medical records already submitted showing a surgery, priced by CMS, that … READ MORE

On December 17, 2012 CMS announced they will be updating the life tables that allocators use when calculating life expectancy in WCMSAs. The impact will be an overall increase in life expectancy, although minimally, which will result in slightly higher costs in some situations. It is important to know that if a file has a pending WCMSA timely submission is … READ MORE

Lyrica is one of the most expensive chronically prescribed drugs used in workers compensation spine/back cases. Lyrica is a anticonvulsant drug used to treat chronic neuropathic back or spine pain, such as pain in a leg that persists after a lumbar spine injury. Prior to Lyrica, Gabapentin had been the primary anticonvulsant drug used for neuropathic pain, and its cost … READ MORE

We previously thought Workers’ Compensation Medicare Set-aside Arrangements (WCMSA) funds were sacrosanct and not available for any other purpose, except to pay for medical care related to the settled workers’ compensation injury. This does not appear to be the case in Illinois. A recent Appellate Court decision from the Third District of Illinois has muddied the waters for what was … READ MORE

The worker’s compensation system has been notorious for settlement of a “denied claim.” These are the claims where the cost to litigate the matter is greater than the settlement options. Thus, in exchange for a sum of money the Claimant agrees to discontinue their application for WC benefits. Over the years we have witnessed the Centers for Medicare and Medicaid … READ MORE